COORDINATED CHRONIC DISEASE and health promotion program

93.544 / Healthy Communities, Tobacco Control, Diabetes Prevention and Control, And Behavior
State Project/Program: / Coordinated Chronic Disease and Health promotion program
U. S. Department of Health and Human Services

Centers for Disease Control and Prevention

Federal Authorization: /

Public Health Service Act, as amended, Sections 301, 307, 310, 311, 317, 322(e), 325, 327, 328, 352 and 361-369; Occupational Safety and Health Act of 1970; Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Act of 1988, Public Law 100-202

State Authorization: /

N/A

N. C. Department of Health and Human Services

Division of Public Health

Agency Contact Person Program

April Reese

Diabetes Prevention and Control Program

(919) 707-5344


Agency Contact Person – Financial
Judith McDermott
Chief Budget Officer
(919) 707-5080
/ N. C. DHHS Confirmation Reports:
SFY 2014 audit confirmation reports for payments made to Counties, Managed Care Organizations (MCOs or, formerly, Local Management Entities), Boards of Education, Councils of Government, District Health Departments and DHSR Grant Subrecipients will be available by early September at the following web address: http://www.ncdhhs.gov/control/auditconfirms.htm. At this site, click on the link entitled “Audit Confirmation Reports (State Fiscal Year 2013-2014)”. Additionally, audit confirmation reports for Nongovernmental entities receiving financial assistance from the DHHS are found at the same website except select “Non-Governmental Audit Confirmation Reports (State Fiscal Years 2012-2014)”.

The auditor should not consider the Supplement to be “safe harbor” for identifying audit procedures to apply in a particular engagement, but the auditor should be prepared to justify departures from the suggested procedures. The auditor can consider the Supplement a “safe harbor” for identification of compliance requirements to be tested if the auditor performs reasonable procedures to ensure that the requirements in the Supplement are current. The grantor agency may elect to review audit working papers to determine that audit tests are adequate.

I.  PROGRAM OBJECTIVES

Nationally, the Centers for Disease Control and Prevention (CDC), along with other federal agencies addressing health, have been seeking to address requirements of the Affordable Care Act designed to help move the nation away from a health care system focused on sickness and disease, to one focused on wellness and prevention. An important outcome of this effort is the National Prevention Strategy (NP Strategy), which is a comprehensive plan to help increase the number of Americans who are healthy at every stage of life (National Prevention, Health Promotion, and Public Health Council, 2011).

Centers for Disease Control and Prevention (CDC) funding, provided to all 50 states, was established to build and strengthen state health department capacity to effectively prevent chronic disease and promote health by:

·  Ensuring that every state has a strong foundation in chronic disease prevention and control;

·  Maximizing the reach of categorical chronic disease programs by sharing cross-cutting services;

·  Providing leadership and expertise to work collaboratively across chronic diseases, conditions, and risk factors to most effectively meet population health needs, especially for populations at greatest risk or with the greatest burden; and

·  Improving CDC’s assistance to state health departments

With this funding, North Carolina will:

·  Develop a chronic disease, injury and health promotion plan that will outline goals and objectives to reduce morbidity and mortality due to chronic disease and injury. This plan will include specific intervention to be conducted by internal and external stakeholders. It will be based on activities that fall into four domains:

·  Domain 1: Epidemiology and Surveillance: Gather, analyze, and disseminate data and information and conduct evaluation to inform, prioritize, deliver, and monitor programs and population health.

·  Domain 2: Environmental approaches that promote health and support and reinforce healthful behaviors (statewide in schools, worksites, and communities).

·  Domain 3: Health system interventions to improve the effective delivery and use of clinical and other preventive services in order to prevent disease, detect diseases early, and reduce or eliminate risk factors and mitigate or manage complications.

·  Domain 4: Strategies to improve community-clinical linkages ensuring that communities support and clinics refer patients to programs that improve management of chronic conditions. Such interventions ensure those with or at high risk for chronic diseases have access to quality community resources to best manage their conditions or disease risk.

·  Provide essential training and professional development opportunities to staff to increase capacity in the above mentioned domains.

·  Adjust the organizational structure to support coordinated chronic disease and injury prevention and health promotion.

·  Train DPH management staff in how to lead and manage organizational change.

The North Carolina Department of Health and Human Services was awarded a three year cooperative agreement, centers for disease control and prevention (CDC) – Investigations and technical assistance (b); a supplemental multi-grant for Tobacco, Diabetes, the Behavioral Risk Factor Surveillance System, and Healthy Communities. The grant award period is September 1, 2011 – March 28, 2014.

II.  PROGRAM PROCEDURES

Contract:

·  The Coordinated Chronic Disease program will engage a university partner to assist with development of the Coordinated Chronic Disease, Injury and Health Promotion State Plan and evaluation of integrated and coordinated activities.

III.  COMPLIANCE REQUIREMENTS

In developing the audit procedures to test compliance with the requirements for a federal funded program, the auditor should look first at OMB Circular A-133, Part 2, Matrix of Compliance Requirements, to identify which of the 14 types of compliance requirements described in Part 3 are applicable and then look to Part 3 for the details of the requirements.

A.  Activities Allowed or Disallowed

CDC funds must be used for focused strategies to change systems, develop and implement policies, change the environment in which tobacco use occurs, and impact population groups rather than individuals. Other appropriate uses of funding include:

·  Staff salaries, wages and fringe benefits

·  Consultant and subcontractor fees and expenses

·  Educational and promotional materials

·  Education of community leaders and decision makers

·  Convening interested groups

·  Policy analysis

·  Computer and printer

·  Printing

·  Office supplies

·  Travel in State

In addition CDC funds cannot be used for:

·  Capital expenditures

·  To supplant funds from federal or State sources

·  Clinical care and pharmaceutical products

·  Equipment expenses over $3,000

·  To support or engage in any effort to participate in political activities or lobbying, including but not limited to support of or opposition to candidates, ballot initiatives, referenda and other similar activities

·  Fund raising

·  Payment of non-program related debts, fines or penalties

·  Contributions to a contingency fund

·  Membership fees

·  Interest or other financial payments

·  Travel and meals in excess of the health department or current North Carolina State rates

·  Replacement of operation funds

·  Research

·  Staff time to provide direct classroom instruction of students

Suggested Audit Procedure

Review the executed contract to determine approved budget items and review expenditure documentation to determine the appropriateness of specific activities paid by these funds.

B.  Allowable Costs / Cost Principles

All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the cost principles described in the N. C. Administrative Code at 09 NCAC 03M .0201. Basic Considerations, Indirect Costs, Direct Costs, Allowable Costs, and Unallowable Costs may be found in the latest version of the federal Office of Budget and Management (OMB) Circular 122 or OMB Circular A-87 available from the OMB website at www.whitehouse.gov/OMB/circulars.

E.  Eligibility

CDC funded activities serve all North Carolinians who are at risk or who have chronic diseases and those who have suffered from unintended injuries and those who may be protected from injury.

Suggested Audit Procedure

Review the local health departments Consolidated Contract and Agreement Addendum requirements and all expenditure documentation to determine if groups targeted for interventions are the actual beneficiaries of the activities.

F.  Equipment and Real Property Management

Coordinated funding can be used to support staff and for a variety of expenses associated with developing and implementing activities in the approved contracts. Prior approval is required from the Chronic Disease and Injury Section for any equipment, computer purchases and disposition of the equipment in accordance to State laws and procedures.

Suggested Audit Procedure

Review contractors’ files for addition or disposition of equipment and Branch approval.

G. Matching, Level of Effort, Earmarking

No matching funds are required with this funding.

H.  Period of Availability of Federal or State Funds

CDC funds are allocated to the contractor through the NC Division of Public Health from July 1, 2013 – March 28, 2014.

I.  Procurement and Suspension and Debarment

All grantees that expend federal funds (received either directly from a federal agency or passed through the N. C. Department of Health and Human Services) are required to conform to federal agency codifications of the grants management common rule accessible on the Internet at http://www.whitehouse.gov/omb/grants/chart.html.

All grantees that expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are required to comply with the procurement standards described in the North Carolina General Statutes and the North Carolina Administrative Code, which are identified in the State of North Carolina
Agency Purchasing Manual accessible on the Internet at http://www.doa.state.nc.us/PandC/agpurman.htm#P6_65.

Nongovernmental subrecipients shall maintain written Procurement policies that are followed in procuring the goods and services required to administer the program.

L.  Reporting
Contractor must submit monthly expenditure reports for reimbursement. The contractor must submit monthly performance reports describing accomplishments toward activity requirements described in the activities chart and Scope of Work.
Suggested Audit Procedure

Review the files (electronic and paper) for evidence of bi-annual site visit reports.

M.  Subrecipient Monitoring

The contractor shall not subcontract any of the work contemplated under this contract without obtaining prior written approval from the Division. Any approved subcontract shall be subject to all conditions of this contract.

Suggested Audit Procedure

Review the local health departments Consolidated Contract and Agreement Addendum requirements for the specific, detailed subrecipient monitoring requirements.

N.  Special Tests and Provisions

Conflicts of Interest and Certification Regarding No Overdue Tax Debts

All non-State entities (except those entities subject to the audit and other reporting requirements of the Local Government Commission) that receive, use or expend State funds (including federal funds passed through the N. C. Department of Health and Human Services) are subject to the financial reporting requirements of G. S. 143C-6-23 for fiscal years beginning on or after July 1, 2007. These requirements include the submission of a Notarized Conflict of Interest Policy (see G. S. 143C-6-23(b)) and a written statement (if applicable) completed by the grantee’s board of directors or other governing body that the entity does not have any overdue tax debts as defined by G. S. 105-243.1 at the federal, State or local level (see G. S. 143C-6-23(c)). All non-State entities that provide State funding to a non-State entity (except any non-State entity subject to the audit and other reporting requirements of the Local Government Commission) must hold the subgrantee accountable for the legal and appropriate expenditure of those State grant funds.

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